What To Do If My Worker’s Compensation Claim is Denied in California

March 23, 2021 Posted In Work-related injury

After a work-related injury, one of the biggest concerns is if you will be able to cover your medical expenses, ongoing treatment, and lost wages. Workers’ compensation is meant to provide those benefits, but unfortunately, there are times when legitimate claims are denied. While this is a frustrating situation, it is important to know you still have options. 

Steps To Take if Your Workers’ Compensation Claim is Denied

1. Speak to a Workers’ Compensation Attorney. The process and laws surrounding workers’ compensation claims are complex. An attorney can guide you through the appeals process to ensure you receive the benefits you are entitled to. You only have 20 days to appeal the decision from the day you receive a letter stating your claim is denied. Twenty-five days if the letter was mailed.                       
2. File a Formal Claim. The first step in appealing the claim’s administrator’s initial decision is to file a case at an office of the California Division of Workers’ Compensation (DWC). Fill out an application for adjudication of claim, and each party, including the claims administrator, must be served the application. 
3. Wait for Notification. You should receive a notification from the DWC confirming your application is on record and what your case number is. 
4.  Request a Hearing. Another document called the, “Declaration of Readiness” must be filed to request a hearing to appear before an administrative law judge. The hearing, also known as a mandatory settlement conference (MSC), will be scheduled. 
5. The Hearing. You and your attorney, the claims administrator, and their attorney, and a judge will all be present. During the MSC, the judge will discuss your case in an attempt to reach a settlement. If it fails, then your next option is trial before a different judge. 
6. Trial. After the trial, the judge will send a decision by mail in the following 30 to 90 days. If either side disagrees with the judge’s decision, a Petition for Reconsideration can be filed.
7. Request Reconsideration. This petition will be sent to the appeals board, who will then have 60 days to either accept or deny it. If you do not receive a response within that time, it means your petition is denied. 
8. Writ of Review. If your Petition for Reconsideration is denied, you can file for a “writ of review” within 45 days. Any issue in the Writ must have been included in the Petition for Reconsideration. Your attorney will file this petition with the California Court of Appeal in your district. The appellate court will determine if the appeals board reached a reasonable conclusion. 

Reasons Why Workers’ Compensation Claims are Denied

Some of the most common reasons for claim denials are: 

Injury Wasn’t Reported in Time

If you fail to report your injury to your employer within 30 days.

You Aren’t Eligible 

If you weren’t at work or acting on behalf of your employer when you were injured, then you aren’t eligible. 

Workers’ Comp Claim Wasn’t Filed on Time

You have up to one year from the date of injury to file the DWC-1 claim form. Failure to meet this deadline will automatically result in a denial. 

No Medical Treatment

You must have proof of medical treatment before your claim is approved.

Your Employer Disputes Your Claim 

Your employer may choose to dispute your work injury or claim that it occurred due to another disqualifying reason.

Speak to a Riverside Workers’ Compensation Lawyer Today

Our Riverside workers’ compensation lawyers at Hanson & Mouri are dedicated to helping injured workers get the benefits they need and deserve. Contact us for a free consultation today.